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See Inside October 2005

Upsetting Psychotherapy

Pressure from insurance companies and competition from drug therapies are prompting analysts to get patients off the couch more quickly


WENDY SPENT FIVE YEARS in psychoanalysis, delving so deeply into her mind that she could no longer see the connection between her adult problems and her teenage episodes of “cutting” her wrists. After she and her analyst had their final session, during which he welcomed her to move on with her life, Wendy was not completely happy, but she was happier than she ever had been. And that, psychologists say, is successful therapy.

Psychoanalysis probes the unconscious mind to unlock the mysteries that drive conscious emotions and behavior. The discipline is built on pillars set by Sigmund Freud a century ago. It is characterized by frequent sessions that can take place over many years, wherein patients are encouraged to freely associate whatever comes to mind as the analyst sits quietly and listens.

Today the practice is changing. The transformation is in part the result of a better understanding of what works during self-analysis. But increasingly, psychotherapy is changing just to survive, held hostage to limits on insurance coverage determined by managed care companies and facing replacement by psychoactive drugs that in the long run are far cheaper than a patient's weekly visit to the therapist's office. In this incarnation, it suddenly matters less that symptoms may disappear without patients figuring out the underlying cause.

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